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jour-Abalone Farm Notification

jour-Abalone Farm Notification - participation and...

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Field Activities Notification Identified Risk, Informed Consent and Hold Harmless Course # Section # Title: Term: Faculty/Leader (s): Activity(ies) Title: Requirements for this course include participation in activities out of the classroom, campus lab, and shops. These activities are required by: Alternative assignment(s) are/are not available, contact: Schedule and Logistics for Activities: Date(s) Time(s) Destination(s) Site Activity(ies) Fees and Expenses: Transportation, Lodging, Food, Equipment: Expected Site Conditions :
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Identified Risks : 1. Bodily Injury, Possible Resulting Disability and/or death 2. Damage to Personal Property 3. Liability for injury to others and/or damage to property of others ------------------------------------------------------------------------------------------------------------ This list of identified risks related to this activity/event is intended to assist participant in evaluating the risk of
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Unformatted text preview: participation and assumption of those risks through participation in this course. Additional risks, foreseen and unforeseeable, common and uncommon, may also exist and are assumed through informed consent. Participant additionally agrees to hold the University harmless for consequences of their own acts of negligence as well as the negligent acts of others. Additional detailed information will be provided in advance as necessary for specific Field Activities *Please contact the instructor within the first week of class and/or before the first Field Activity if you require accommodation for participation or have a condition which may impact your participation.* _____________________________________________ Printed Name _____________________________________________ _______________ Signature Date...
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